[Echocardiographic aspects of pericardial metastases. Apropos of 7 cases]

Modern two-dimensional imaging is of such quality that echocardiography is now capable of detecting intrapericardial formations. Three morphological types of abnormal intrapericardial echoes have been described: round masses, mattresses and linear echoes. These have been observed in effusions of various origin and seem to be lacking in aetiological specificity. In order to determine more precisely the echocardiographic signs of pericardial metastases, the authors have analyzed 7 cases of intrapericardial masses visualized in a series of 10 patients with metastatic pericardial effusion and examined in two-dimensional mode. These were echogenic and dense masses implanted on the pericardium and subject to cyclic movements linked with those of that membrane. Morphologically, they fell into two categories: round and sessile masses (6 cases) 8 to 23 mm high and 22 to 48 mm wide at their implantation; they were found mostly opposite the cardiac apex (4 cases) and/or in the lateral wall of the right ventricle (3 cases), oval formations (2 cases) which were 70 mm long and 17 mm wide in one case and 50 mm long and 15 mm wide in the other. One patient had two masses of different shapes. A review of the literature showed that these two echocardiographic images corresponded to two macroscopic types of pericardial invasion: either tumoral nodules or infiltration plaques betraying a diffuse invasion of the pericardium. All masses observed by the authors were located on the visceral leaflet of the pericardium. This predominantly epicardial location might be due to the visceral leaflet being selectively invaded by retrograde lymphatic embolization from the mediastinal lymph nodes.(ABSTRACT TRUNCATED AT 250 WORDS)